Liability Claims Adjuster

Cynet Systems • Eden Prairie, MN

1d

About The Position

To analyze mid- and higher-level general liability claims to determine benefits due, ensure ongoing adjudication of claims within company standards and industry best practices, and identify subrogation of claims and negotiate settlements.

Requirements

• Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices, and Social Security and Medicare application procedures as applicable to line-of-business.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.
• Analytical and interpretive skills.
• Strong organizational skills.
• Good interpersonal skills.
• Excellent negotiation skills.
• Ability to work in a team environment.
• Ability to meet or exceed Service Expectations.
• Four (4) years of claims management experience or equivalent combination of education and experience required.

Responsibilities

• Manages mid-level general liability claims by gathering information to determine liability exposure, assigns reserve values to claims, makes claims payments as necessary, and settles claims up to designated authority level.
• Assesses liability and resolves claims within evaluation.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.
• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level